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Preserving Moral Integrity: A Follow-Up Study With New Graduate Nurses

Author

Kelly, Brighid

Bibliographic Citation

Journal of Advanced Nursing. 1998 Nov; 28(5): 1134-1145.

Abstract

The purpose of this follow-up study was to describe, explain and
interpret how new graduate nurses perceived their adaptation to the 'real
world' of hospital nursing and what they perceived as major influences on
their moral values and ethical roles in the 2 years following graduation. The
method was qualitative, specifically grounded theory. The earlier study took
place when informants were senior nursing students. The follow-up study began
after the informants had been practising for 1 year. Research questions
guiding the study were: How do new graduate nurses describe their adaptation
to the 'real world' of hospital nursing? What do they describe as factors
influencing their moral values and ethical roles in hospital nursing?
Preserving moral integrity was the basic psycho-social process that explained
how these new graduate nurses adapted to the real world of hospital nursing.
Six stages of this process were identified: vulnerability; getting through the
day; coping with moral distress; alienation from self; coping with lost
ideals; and integration of new professional self-concept. Moral distress was a
consequence of the effort to preserve moral integrity. It is the result of
believing that one is not living up to one's moral convictions. Data supported
that the most pervasive attributes of moral distress were self-criticism and
self-blame, as informants judged their actions against their moral convictions
and their standards of what a good nurse would do. Moral distress was an acute
form of psychological disorientation in which informants questioned their
professional knowledge, what kind of nurses they were and what kind of nurses
they were becoming. Theoretical explanations of these findings are grounded in
social interaction and moral psychology theories.